Provider Demographics
NPI:1942566229
Name:BOVINO, JERALD ARTHUR
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:ARTHUR
Last Name:BOVINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4395
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81612-4395
Mailing Address - Country:US
Mailing Address - Phone:970-925-9095
Mailing Address - Fax:970-544-5838
Practice Address - Street 1:804 HUNTER CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611
Practice Address - Country:US
Practice Address - Phone:970-925-9095
Practice Address - Fax:970-544-5838
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35,042988207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology